Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | E88750 | SC |
NPI | 1134121718 |
---|---|
Provider Name | Andrew Evin Davidson |
First Address | Summerville, SC 29485-8106 |
Second Address | Summerville, SC 29485-8106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 16/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200507 | (05) | SC |
E88750 | (02) | SC |